Provider Demographics
NPI:1285645887
Name:DELGADO, RAUL A (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:A
Last Name:DELGADO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CALLE OPALO
Mailing Address - Street 2:CHALETS DE SANTA CLARA
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-6855
Mailing Address - Country:US
Mailing Address - Phone:787-792-0303
Mailing Address - Fax:787-792-0303
Practice Address - Street 1:U3-12 CARR 21
Practice Address - Street 2:LAS LOMAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3313
Practice Address - Country:US
Practice Address - Phone:787-792-0303
Practice Address - Fax:787-792-0303
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR25031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice